Ureterocalicostomy for treatment of complex cases of ureteropelvic junction obstruction in adults.

OBJECTIVES: To evaluate ureterocalicostomy (UC) in the management of selected cases of ureteropelvic junction (UPJ) obstruction. METHODS: The data from 22 patients who underwent UC from April 2002 to April 2009 were reviewed. The indications for UC were primary UPJ obstruction with completely intrarenal pelves (2 cases), complicated (secondary or recurrent) UPJ obstruction with an intrarenal pelvis and/or reversed caliceopelvic ratio (16 cases) and after iatrogenic injury at the UPJ (4 cases). The evaluation of treatment outcome was performed subjectively by symptom assessment and objectively using ultrasonography, radiography, and radioisotope diuretic renography. RESULTS: After a mean follow-up of 26.7±20.99 months, UC success was achieved in 16 patients (73%), with complete cure in 12 and improvement in 4. In 2, the condition remained stable, and failure occurred in 4 patients. Of these 4 patients, 2 underwent nephrectomy and 2 were treated with indwelling double-J stents with frequent exchanges. CONCLUSIONS: The results of UC in the present study were satisfactory. The procedure could be the best alternative in the case of complex UPJ obstruction in the presence of intrarenal pelvis and/or when the degree of calicectasis is greater than that of pyelectasis.

Extracorporeal shock wave lithotripsy of lower ureteric stones: Outcome and criteria for success.

OBJECTIVE: To evaluate the efficacy of extracorporeal shock wave lithotripsy (ESWL) for distal ureteric calculi (DUC) and to determine variables that could affect the outcome results. PATIENTS AND METHODS: Between April 2004 and February 2008, 100 patients with a solitary DUC were treated with in situ ESWL using a lithotripter (Lithostar Plus, Siemens, Erlangen, Germany). The outcome of treatment was evaluated after 3 months. The patients' clinical and radiological findings, as well as stone characteristics, were reviewed and correlated with the stone-free rate (SFR). RESULTS: After in situ ESWL, 84 patients (84%) were stone-free (after one session in 57 and after two in 27). From a univariate analysis only three factors had a significant impact on the SFR, i.e. the body mass index (BMI), stone length and stone width. The SFR was significantly lower in obese patients than in normal and overweight patients (P = 0.019). Stone width ⩾8 mm was associated with a SFR of 64% (14/22), compared with 89.7% (70/78) for those with a stone width of <8 mm (P = 0.007). The SFR was 86.8% (66/76) for a stone length of ⩽10 mm and 71% (17/24) for a stone length of >10 mm (P = 0.016). On multivariate analysis, BMI, stone width and stone length maintained their statistical significance. CONCLUSION: Primary in situ ESWL remains an effective and safe form of treatment for DUC. The length and transverse diameter of the stone, together with the BMI of the patient, were the only significant predictors of the overall success of ESWL.

Insertion of double J stent as a therapeutic test in management of adults presenting with loin pain and equivocal ureteropelvic junction obstruction.

PURPOSE: To evaluate temporary double J ureteric stenting (TDJS) as a test to diagnose ureteropelvic junction obstruction (UPJO) in equivocal cases. MATERIALS AND METHODS: One hundred and nine consecutive adult patients with loin pain and ipsilateral equivocal UPJO (EqUPJO) on radioisotope diuretic renogram (RDR) were enrolled in the present study. All patients underwent TDJS for 3 weeks. According to the response (relief of pain) to TDJS, which was assessed by visual analogue pain score (VAPS), patient preference and further management, patients were classified into five groups: Group Ia non-responders who elected conservative treatment for their condition, Group Ib non-responders who elected intervention, Group IIa responders who elected conservative treatment and Group IIb responders who elected intervention. Last group patients were randomized to either early (Group IIb(1)) or delayed intervention 3 months later (Group IIb(2)). Intervention was in the form of pyeloplasty (24 patients) and endopyelotomy (38 patients). All patients were followed up by measuring VAPS and RDR. RESULTS: After at least 6 months from management decision, 97 patients were available for evaluation. The VAPS dropped by 21.25% (P < 0.001), 32% (P = 0.004), 2% (P = 0.6), 54% (P < 0.001) and 65% (P < 0.001) in groups Ia, Ib, IIa, IIb1, and IIb2, respectively. On the other hand the T (1/2) of RDR dropped significantly only in groups Ib, IIb1, and IIb2 by a mean of 6.5 min (P = 0.005), 8.02 min (P < 0.001), and 7.3 min (P < 0.001), respectively. CONCLUSION: TDJS in cases of EqUPJO with loin pain is helpful in defining cases suitable for intervention versus conservative treatment.